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Influence of BMI and geographical region on prescription of oral anticoagulants in newly diagnosed atrial fibrillation: The GLORIA-AF Registry Program

      Highlights

      • In patients with newly diagnosed atrial fibrillation the distribution of BMI differed among the continents.
      • An increased BMI was associated with a lower probability of non-prescription of OACs, as compared with a normal BMI.
      • The probability of non-prescription of OACs was increased in the Asia or North America regions, as compared with Europe.

      Abstract

      Objective

      To investigate the association between body mass index (BMI) and oral anticoagulant (OAC) prescription in atrial fibrillation (AF).

      Methods

      Patients with newly diagnosed non-valvular AF (<3 months) with ≥1 stroke risk factors enrolled in the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) in Asia, Europe and North America were evaluated.

      Results

      The cohort (n = 13,793) comprised patients from all BMI categories (kg/m2): 1.4% were underweight (<18.5), 27.3% had a normal BMI (18.5 to <25), 37.9% were overweight (25 to <30), 19.3% were moderately obese (30 to <35), and 12.7% were morbidly obese (≥35). The highest proportion of Asians had a BMI of 18.5 to <25 kg/m2, while the highest proportion of patients from Europe and North America were overweight and a substantial proportion of North Americans morbidly obese. In the multivariable analysis, the probability ratio of non-prescription of OAC, as compared to normal BMI, decreased for overweight (RR = 0.907), moderately obese (RR = 0.802) and severe very severe obese patients (RR = 0.659). Moreover, the probability ratio of non-prescription of OACs was increased in the Asia or North America regions, as compared with Europe, in patients aged <65 years or female patients, as well as in patients with prior bleeding or vascular disease.

      Conclusions

      The distribution of BMI differed among the continents. An increased BMI was associated with a lower probability of non-prescription of OACs, as compared with a normal BMI. The probability of non-prescription of OACs was increased in the Asia or North America regions, as compared with Europe.

      Keywords

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      References

        • Whitlock G.
        • Lewington S.
        • Sherliker P.
        • Clarke R.
        • Emberson J.
        • Halsey J.
        • et al.
        Body-mass index and cause-specific mortality in 900 000 adults: Collaborative analyses of 57 prospective studies.
        Lancet. 2009; 373: 1083-1096
        • Wang T.J.
        • Parise H.
        • Levy D.
        • D'Agostino R.B.
        • Wolf P.A.
        • Vasan R.S.
        • et al.
        Obesity and the risk of new-onset atrial fibrillation.
        JAMA. 2004; 292: 2471-2477
        • Badheka A.O.
        • Rathod A.
        • Kizilbash M.A.
        • Garg N.
        • Mohamad T.
        • Afonso L.
        • et al.
        Influence of obesity on outcomes in atrial fibrillation: Yet another obesity paradox.
        Am J Med. 2010; 123: 646-651
        • Sandhu R.K.
        • Ezekowitz J.
        • Andersson U.
        • Alexander J.H.
        • Granger C.B.
        • Halvorsen S.
        • et al.
        The 'obesity paradox' in atrial fibrillation: Observations from the aristotle (Apixaban for reduction in stroke and other thromboembolic events in atrial fibrillation) trial.
        Eur Heart J. 2016; 37: 2869-2878
        • Balla S.R.
        • Cyr D.D.
        • Lokhnygina Y.
        • Becker R.C.
        • Berkowitz S.D.
        • Breithardt G.
        • et al.
        Relation of risk of stroke in patients with atrial fibrillation to body mass index (from patients treated with rivaroxaban and warfarin in the rivaroxaban once daily oral direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation trial).
        Am J Cardiol. 2017; 119: 1989-1996
        • Boriani G.
        • Ruff C.T.
        • Kuder J.F.
        • Shi M.
        • Lanz H.J.
        • Rutman H.
        • et al.
        Relationship between body mass index and outcomes in patients with atrial fibrillation treated with edoxaban or warfarin in the ENGAGE AF-TIMI 48 trial.
        Eur Heart J. 2019;
        • Camm A.J.
        • Fox K.A.A.
        • Peterson E
        Challenges in comparing the non-vitamin K antagonist oral anticoagulants for atrial fibrillation-related stroke prevention.
        Europace. 2018; 20: 1-11
        • Camm A.J.
        • Fox K.A.A.
        Strengths and weaknesses of 'real-world' studies involving non-vitamin K antagonist oral anticoagulants.
        Open Heart. 2018; 5e000788
        • Huisman M.V.
        • Rothman K.J.
        • Paquette M.
        • Teutsch C.
        • Diener H.C.
        • Dubner S.J.
        • et al.
        Antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation: The GLORIA-AF registry, phase II.
        Am J Med. 2015; 128: 1306-1313
        • Huisman M.V.
        • Lip G.Y.
        • Diener H.C.
        • Dubner S.J.
        • Halperin J.L.
        • Ma C.S.
        • et al.
        Design and rationale of global registry on long-term oral antithrombotic treatment in patients with atrial fibrillation: A global registry program on long-term oral antithrombotic treatment in patients with atrial fibrillation.
        Am Heart J. 2014; 167: 329-334
        • Lip G.Y.H.
        • Banerjee A.
        • Boriani G.
        • Chiang C.E.
        • Fargo R.
        • Freedman B.
        • et al.
        Antithrombotic therapy for atrial fibrillation: Chest guideline and expert panel report.
        Chest. 2018; 154: 1120-1121
        • Austin P.C.
        Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples.
        Stat Med. 2009; 28: 3083-3107
        • Austin P.C.
        An introduction to propensity score methods for reducing the effects of confounding in observational studies.
        Multivariate Behav Res. 2011; 46: 399-424
        • Azur M.J.
        • Stuart E.A.
        • Frangakis C.
        • Leaf P.J
        Multiple imputation by chained equations: What is it and how does it work?.
        Int J Methods Psychiatr Res. 2011; 20: 40-49
        • Deddens J.A.
        • Petersen M.R.
        Approaches for estimating prevalence ratios.
        Occup Environ Med. 2008; 65 (481): 501-506
        • Mazurek M.
        • Huisman M.V.
        • Lip G.Y.H
        Registries in atrial fibrillation: From trials to real-life clinical practice.
        Am J Med. 2017; 130: 135-145
        • Boriani G.
        • Proietti M.
        • Laroche C.
        • Fauchier L.
        • Marin F.
        • Nabauer M.
        • et al.
        Contemporary stroke prevention strategies in 11 096 European patients with atrial fibrillation: A report from the EURObservational research programme on atrial fibrillation (EORP-AF) long-term general registry.
        Europace. 2018; 20: 747-757
        • Boriani G.
        • Proietti M.
        • Laroche C.
        • Diemberger I.
        • Popescu M.I.
        • Riahi S.
        • et al.
        Changes to oral anticoagulant therapy and risk of death over a 3-year follow-up of a contemporary cohort of European patients with atrial fibrillation final report of the EURObservational research programme on atrial fibrillation (EORP-AF) pilot general registry.
        Int J Cardiol. 2018; 271: 68-74
        • Mazurek M.
        • Huisman M.V.
        • Rothman K.J.
        • Paquette M.
        • Teutsch C.
        • Diener H.C.
        • et al.
        Regional differences in antithrombotic treatment for atrial fibrillation: Insights from the GLORIA-AF phase II registry.
        Thromb Haemost. 2017; 117: 2376-2388
        • Camm A.J.
        • Pinto F.J.
        • Hankey G.J.
        • Andreotti F.
        • Hobbs F.D.
        • Writing Committee for the Action for Stroke Prevention Alliance
        Non-vitamin K antagonist oral anticoagulants and atrial fibrillation guidelines in practice: Barriers to and strategies for optimal implementation.
        Europace. 2015; 17: 1007-1017
        • Boriani G.
        • Laroche C.
        • Diemberger I.
        • Fantecchi E.
        • Meeder J.
        • Kurpesa M.
        • et al.
        Overweight and obesity in patients with atrial fibrillation: Sex differences in 1-year outcomes in the EORP-AF general pilot registry.
        J Cardiovasc Electrophysiol. 2018; 29: 566-572
        • Proietti M.
        • Guiducci E.
        • Cheli P.
        • Lip G.Y
        Is there an obesity paradox for outcomes in atrial fibrillation? A systematic review and meta-analysis of non-vitamin K antagonist oral anticoagulant trials.
        Stroke. 2017; 48: 857-866
        • Proietti M.
        • Boriani G.
        Obesity paradox in atrial fibrillation: Implications for outcomes and relationship with oral anticoagulant drugs.
        Am J Cardiovasc Drugs. 2020; 20: 125-137
        • Pathak R.K.
        • Middeldorp M.E.
        • Meredith M.
        • Mehta A.B.
        • Mahajan R.
        • Wong C.X.
        • et al.
        Long-term effect of goal-directed weight management in an atrial fibrillation cohort: A long-term follow-up study (LEGACY).
        J Am Coll Cardiol. 2015; 65: 2159-2169
        • Rocca B.
        • Fox K.A.A.
        • Ajjan R.A.
        • Andreotti F.
        • Baigent C.
        • Collet J.P.
        • et al.
        Antithrombotic therapy and body mass: An expert position paper of the ESC working group on thrombosis.
        Eur Heart J. 2018; 39 (1672-86f)
        • Tittl L.
        • Endig S.
        • Marten S.
        • Reitter A.
        • Beyer-Westendorf I.
        • Beyer-Westendorf J
        Impact of BMI on clinical outcomes of NOAC therapy in daily care - results of the prospective dresden NOAC registry (NCT01588119).
        Int J Cardiol. 2018; 262: 85-91
        • Proietti M.
        • Lane D.A.
        • Boriani G.
        • Lip G.Y.H
        Stroke prevention, evaluation of bleeding risk, and anticoagulant treatment management in atrial fibrillation contemporary international guidelines.
        Can J Cardiol. 2019; 35: 619-633
        • Boriani G.
        • Laroche C.
        • Diemberger I.
        • Fantecchi E.
        • Popescu M.I.
        • Rasmussen L.H.
        • et al.
        'Real-world' management and outcomes of patients with paroxysmal vs. non-paroxysmal atrial fibrillation in Europe: The EURObservational research programme-atrial fibrillation (EORP-AF) general pilot registry.
        Europace. 2016; 18: 648-657
        • Son M.K.
        • Lim N.K.
        • Kim H.W.
        • Park H.Y
        Risk of ischemic stroke after atrial fibrillation diagnosis: A national sample cohort.
        PLoS ONE. 2017; 12e0179687
        • Boriani G.
        • Savelieva I.
        • Dan G.A.
        • Deharo J.C.
        • Ferro C.
        • Israel C.W.
        • et al.
        Chronic kidney disease in patients with cardiac rhythm disturbances or implantable electrical devices: Clinical significance and implications for decision making-a position paper of the European heart rhythm association endorsed by the heart rhythm society and the Asia Pacific heart rhythm society.
        Europace. 2015; 17: 1169-1196
        • Steffel J.
        • Verhamme P.
        • Potpara T.S.
        • Albaladejo P.
        • Antz M.
        • Desteghe L.
        • et al.
        The 2018 European heart rhythm association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation.
        Eur Heart J. 2018; 39: 1330-1393
        • Boriani G.
        • Laroche C.
        • Diemberger I.
        • Popescu M.I.
        • Rasmussen L.H.
        • Petrescu L.
        • et al.
        Glomerular filtration rate in patients with atrial fibrillation and 1-year outcomes.
        Sci Rep. 2016; 6: 30271
        • Malavasi V.L.
        • Pettorelli D.
        • Fantecchi E.
        • Zoccali C.
        • Laronga G.
        • Trenti T.
        • et al.
        Variations in clinical management of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation according to different equations for estimating renal function: Post hoc analysis of a prospective cohort.
        Int Emerg Med. 2018; 13: 1059-1067
        • Marietta M.
        • Banchelli F.
        • Pavesi P.
        • Manotti C.
        • Quintavalla R.
        • Sinigaglia T.
        • et al.
        Direct oral anticoagulants vs non-vitamin K antagonist in atrial fibrillation: A prospective, propensity score adjusted cohort study.
        Eur J Int Med. 2019; 62: 9-16
        • Hirsh J.
        • Eikelboom J.W.
        • Chan N.C
        Fifty years of research on antithrombotic therapy: Achievements and disappointments.
        Eur J Int Med. 2019; 70: 1-7
        • Dreijer A.R.
        • Diepstraten J.
        • Brouwer R.
        • Croles F.N.
        • Kragten E.
        • Leebeek F.W.G.
        • et al.
        Risk of bleeding in hospitalized patients on anticoagulant therapy: Prevalence and potential risk factors.
        Eur J Int Med. 2019; 62: 17-23